Summary: Mr Y complained about how the Council reviewed his mother, Mrs X’s, care and support needs. There were some delays in reviews of Mrs X’s care needs and the Council communicated with Mr Y poorly at times. This caused Mr Y some avoidable frustration for which the Council agreed to apologise. The Council also agreed issue a reminder to its staff about the need for clear communication.

The complaint

1. Mr Y complains, on behalf of his mother, Mrs X, about how the Council reviewed her care and support needs since 2021. He says the Council:
• did not review Mrs X’s care and support plan every year, as it should have done;
• threatened to reduce the amount of money it paid him to care for Mrs X;
• took too long to carry out the review after it agreed to do so in 2024;
• did not provide a suitable new care and support plan; and
• refused to pay him a cost-of-living increase for the care he provides for Mrs X.
2. As a result, Mr Y says he has been caused significant distress and inconvenience, and he had not been paid fairly for the care he has provided. He wants the Council to pay him a financial remedy to recognise the distress is caused, and backdate an increase to the amount the Council pays for Mrs X’s care.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. (Local Government Act 1974, sections 26(1), as amended)
5. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. We may investigate a complaint on behalf of someone who cannot authorise someone to act for them. The complaint may be made by someone we consider to be suitable. (Local Government Act 1974, section 26A(2), as amended)
7. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
8. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

9. I considered evidence provided by Mr Y and the Council as well as relevant law, policy and guidance.
10. Mr Y and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Adult care and support

11. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person
12. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
13. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.

Background

14. Mr Y’s mother, Mrs X, has care and support needs. She has had a care and support plan from the Council for several years, since she moved to its area. The Council meets Mrs X’s care and support needs by making a direct payment to Mr Y, her main carer.
15. When producing Mrs X’s first care and support plan, the Council set the direct payment for Mr Y’s care at the same rate as the council for the area Mrs X moved from. This rate was, and still is, above the Council’s normal rate for direct payments for personal carers.
16. Mr Y contacted the Council in April 2024 asking for an increase in his direct payment rate. He said the Council had not reviewed Mrs X’s care, or the direct payment, for several years. The Council said it needed to carry out a review of Mrs X’s care needs before it could review Mr Y’s direct payments, so it put Mrs X on its waiting list for a review.

My findings

17. Because of both her medical conditions and care and support needs, Mrs X cannot bring a complaint herself, or authorise Mr Y to complain for her. However, Mr Y has lasting power of attorney for Mrs X and so I am satisfied he is a suitable person to complaint on her behalf.

Annual reviews

18. The Council accepted it did not review Mrs X’s care and support plan between 2022 and 2024. The Council said this was because it does not have the capacity within its social care teams to review all care and support plans every year. Instead, it says is prioritises reviews based on individual circumstances.
19. In the circumstances, I accept the Council failed to review Mrs X’s care and support plan due to circumstances outside of its control. Therefore, I consider this was a case of service failure, which it still fault.
20. However, I do not consider this fault led to any injustice. There is no evidence Mrs X’s care needs had changed significantly during that time and Mr Y continued to meet her needs throughout. Mr Y also had contact with the Council during 2023 and there is no evidence he mention that Mrs X needed a review or any changes to her care and support.

2024 review

21. After Mr Y asked for a review in April 2024, the Council added Mrs X to its waiting list for a social worker. There was then a wait of around four months before a social worker was allocated to carry out the review. There is no evidence the Council told Mr Y how long this would take, or that it kept his informed about any delays. Mr Y said he chased the Council during this time, but the Council did not respond to his emails.
22. I consider the delay in allocating a social worker to carry out Mrs X’s review was fault, particularly considering this was very overdue. Again, I consider this was service failure due to the Council’s lack of capacity within its adult social care service. That delay caused Mr Y some avoidable frustration, but did not cause any injustice to Mrs X.

Mrs X’s care and support plan

23. It is not the Ombudsman’s role to decide what care and support Mrs X needs. That is the Council’s responsibility. Our role is to assess whether the Council made its decisions properly. We cannot question a decision the Council has made if it followed the right steps and considered relevant evidence.
24. There was no fault in how the Council reviewed Mrs X’s care and support needs or how it decided what care and support she needed. Once a social worker was allocated, they met with Mrs X, Mr Y, a second carer who had begun to support Mrs X and sought advice from an occupational therapist. The Council considered all the relevant evidence and addressed the correct activities as part of its review.
25. I do not consider there was a delay in the Council referring for occupational therapy advice. The Council did not know, until it visited Mrs X’s home in early October 2024, that Mrs X needed more help moving around. Once the Council became aware of this, it referred Mrs X for that advice and an occupational therapist visited Mrs X in early December 2024.
26. I also do not consider there was a significant delay in the Council carrying out the review, once it had assigned a social worker in August 2024. The Council had produced an updated care and support plan by December 2024. That plan said that Mrs X needed support from an extra carer for two hours a day.
27. After Mr Y said he was not satisfied with the new care and support plan, the Council continued to engage with Mr Y to try to reach an agreement. As part of this, the Council carried out a further review of Mrs X’s needs and produced a new care and support plan in May 2025. That plan increased the extra hours from a second carer to three hours a day.
28. Given the nature of the dispute between Mr Y and the Council, I do not consider there were further delays carrying out that further review.
29. In any case, there was no injustice to Mrs X, since Mr Y and the second carer continued to meet Mrs X needs during that time. The Council also agreed to backdate a direct payment for the second carer to mid-November 2024 which is the first date from which Mr Y and the second carer mentioned those extra hours should be paid.

Direct payments

30. The amount of any direct payments is a decision for the Council to make.
31. I do not consider there was any fault in how the Council decided not to increase Mr Y’s direct payment, or to pay the second carer more than its normal rate. The Council has clearly considered all the information Mr Y provided and explained why it does not consider Mrs X has needs which justify more than the standard rate.
32. The Council also has considered how it would meet Mrs X’s needs in a different way should either Mr Y or the second carer decided they no longer can, or wish to, provide Mrs X’s care.
33. Since there was no fault in how the Council made its decision about the rate of direct payments, I cannot question the Council’s decision.

Communication with Mr Y

34. In its response to Mr Y’s complaint, and in other conversations with him, the Council accepted it had not been as clear or responsive in its communications with him as it should have been. Taking all the Council’s communication with Mr Y into account, I consider that poor communication was fault.
35. However, on the balance of probabilities, I do not consider the Council threatened to reduce Mr Y’s direct payment, or that it intended to lead him to believe this. The Council told Mr Y that his direct payment was significantly higher than its standard rate. However, I consider this was in an effort to manage Mr Y’s expectations about an increase, since Mr Y had mentioned this when he first contacted the Council in 2024.

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Action

36. Within one month of my final decision the Council will apologise to Mr Y for the avoidable frustration and distress caused by the delay in allocating a social worker in 2024 and its poor communication with him.
37. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
38. Within three months of my final decision the Council will remind its adult social care staff about the importance of clear communication, especially with members of the public who are less familiar with the adult social care system.
39. The Council should provide us with evidence it has complied with the above actions.
40. Since the events I have investigated, the Council has taken steps to improve its ability to carry out scheduled reviews on time and keep people better informed during any waits for allocation to a social worker. Based on those improvements, I do not consider I need to make further service improvement recommendations.

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Decision

41. I find fault causing injustice. The Council has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman